Involvement In Hodgkin's Disease Research Articles

The usefulness of Fluorine-18 fluorodeoxyglucose PET-CT in detecting extranodal sites in the initial staging of non-Hodgkin and Hodgkin lymphoma (+ Running poster)

Hodgkin disease (HD) and non-Hodgkin lymphoma (NHL) represent a spectrum of malignant neoplasms arising from the lymphoid system with an incidence of around 8% of all malignancies. Although they are generally known as tumors of lymph nodes, 25% to 40% of HD/NHL tumors, especially NHL, arise at extranodal sites along the gastrointestinal tract, lung, bone, soft tissues, liver, breast, thyroid, and genitourinary tract. the purpose of this study is to identify the extranodal sites in the initial staging of Hodgkin and non-Hodgkin lymphomas by FDG PET/CT. Seventy-six patients with NHL and 30 patients with HD in period 2017–2020 were retrospectively studied. Patients were selected with the following criteria: have biopsy proven histopathological HD or NHL, and extranodal sites on initial FDG PET/CT. The spleen is considered extranodal region in NHL and nodal organ in HD. Seventy-six patients with NHL (51 males, 25 females), extranodal sites correctly identified by 18F-FDG PET/CT: bone ( n = 33), soft tissues ( n = 24), lung ( n = 22), spleen ( n = 15), stomach ( n = 10), adrenal gland ( n = 8), liver ( n = 8), pleura ( n = 7), peritoneum ( n = 7), pericardium ( n = 5), kidney ( n = 4), mammary gland ( n = 3), thyroid ( n = 3), brain ( n = 2), prostate gland ( n = 2), pancreas ( n = 1), testis ( n = 1). Thirty patients with HD (22 males, 8 females), extranodal sites correctly identified by 18F-FDG PET/CT: Bone ( n = 22), lung ( n = 8), liver ( n = 6), pleura ( n = 2), soft tissues ( n = 1), brain ( n = 1). 18F-FDG PET/CT has become the technique of choice for staging and follow-up in patients with extranodal involvement in HD and in most cases of non-NHL. The potential presence of extranodal involvement should be considered when interpreting FDG PET/CT studies. Awareness of the increasing frequency of the appearance of unusual single extranodal sites of involvement in NHL and HD is important, since their presence may change treatment strategy and overall prognosis.

A Clinicopathologic Study of Bone Marrow involvement in Hodgkin Disease

A Clinicopathologic Study of Bone Marrow involvement in Hodgkin Disease

Extranodal involvement in lymphoma - A Pictorial Essay and Retrospective Analysis of 281 PET/CT studies.

The aim of this study is to evaluate the role of PET-CT in identification of different patterns of extranodal involvement in Hodgkin's disease (HD) and Non-Hodgkin's Lymphoma (NHL) and to enlist the common sites of extranodal involvement in each histological type and compare our results with the existing literature. In this retrospective study of 281 cases of lymphomas of various histologies, we illustrate the spectrum of PET/CT features of extranodal lymphoma (ENL) of commonly involved organs and compare our result with the literature. Extranodal appearance in lymphoma is strikingly varied. Diffuse large B cell lymphoma (DLBCL) is the commonest histological subtype and gastrointestinal tract is the commonest anatomical subsite in NHL. Skeletal system is the commonest site for involvement in HD. A broad spectrum of extranodal organs is involved in various subtype of lymphoma which can be depicted in PET-CT in the most appropriate manner. Familiarity with the pattern of involvement is essential for comprehensive management.

Epitrochlear lymph node involvement in Hodgkin disease: A clinical case

Epitrochlear lymph node involvement in Hodgkin disease: A clinical case

Pericardial Involvement in Newly Diagnosed Children and Adolescents with Pediatric Hodgkin's Disease at a Single Children's Cancer Hospital.

Background: Because most cases are clinically silent, incidence, clinical course and outcome of pericardial involvement in Hodgkin disease are unknown.Methods: Records of all 274 newly diagnosed Hodgkin disease patients treated at our institution between 1991 and 2004 were reviewed. Cases were selected on the basis of pericardial involvement with focal thickening or nodularity at the time of presentation identified by CT and/or pericardial effusion on echocardiogram. Variables noted, in addition to basic demographic data, were stage, histologic subtype, clinical presentation, treatment, serial EKG, echocardiography and CT findings, and resolution versus progression of disease. Statistical analysis was performed using SAS version 9.1.Results: The incidence of pericardial involvement in our cohort was 5% (13 of 274 patients). Patient characteristics (age, sex, and race), stage of disease and presence of B-symptoms were equally distributed among affected and unaffected individuals. All 13 cases were nodular sclerosing histology (p=0.02) and 9 (67%) had a bulky mediastinal mass (p=0.002). Of the 13 patients, five had extension into the pericardium by CT, two of which also had pericardial effusion (one large and one massive). Eight patients had only pericardial effusions (trace to large) without other CT findings. Two patients required pericardiocentesis for symptomatic effusions and one underwent pericardial drainage procedure for impending tamponade. Two of the 13 patients relapsed but were successfully salvaged and all remain alive and free of disease at a median follow up of 8.7 years (range, 1.1–11.9 years) and 6.3 years (range 0.4–12.7 years) for patients without pericardial involvement.Conclusions: In our experience, secondary pericardial involvement due to lymphoma is largely asymptomatic unless accompanied by significant effusion. Most of these resolve with treatment of underlying malignancy but require watchful observation for hemodynamic complications. Once treated for symptomatic effusion, there is no difference in mortality amongst various groups. [Display omitted] [Display omitted]

Epidural involvement in Hodgkin's disease.

Epidural involvement is analyzed retrospectively in 512 patients with primary treatment and follow up for Hodgkin's disease (HD) between 1970 and 1999. In one case (0.2%) epidural manifestation was the first symptom and in six cases (1.2%) it occurred later, at a disseminated, advanced stage. All seven patients were male: three had mixed cellularity and four nodular sclerosis histological subtype. The thoracic segment was involved in four cases, the lumbar in two and the cervical segment in one case. The most frequent symptoms were back pain, limb weakness, paresis/plegia, incontinence. Computer tomography, magnetic resonance imaging and myelography were used as diagnostic procedures and in planning the treatment. Functional recovery was achieved by laminectomy, loco-regional irradiation and adjuvant polychemotherapy with remission of HD for 6-100 months. Later, however, six patients died due mainly to relapse/progression of HD. We emphasize the importance of an interdisciplinary approach in the treatment of HD with this relatively rare appearance, which requires close co-operation among oncohematologists, neurologists, radiologists, neurosurgeons, radiotherapists and physiotherapists.

Significance of epitrochlear lymph node involvement in Hodgkin disease

BACKGROUND Epitrochlear involvement in Hodgkin disease (HD) is a rare event, with only limited data available describing this unique presentation, its treatment, and long term outcome. METHODS Between 1968 and 1997, 1180 patients with clinical stage (CS) IA–IIB HD were treated at the Harvard Longwood Area Hospitals, among whom 11 were identified to have presented with epitrochlear lymphadenopathy (1%). Together with 6 CS III–IV patients also with clinically involved epitrochlear lymph nodes at diagnosis, these 17 patients form the basis of the current study. The clinical characteristics, histopathologic distribution, and treatment details are described. Two radiation therapy techniques were used: the “single field” and “separate-field” techniques. The median dose to the epitrochlear region was 3600 centigrays. Survival outcome was calculated by the Kaplan–Meier method. The median follow-up was 17 years. RESULTS The actuarial 15-year freedom from recurrence, cause specific survival, and overall survival (OS) rates for the 17 patients were 70%, 88%, and 70%, respectively. Among the CS IA–IIB patients, the 15-year OS rates of the 1169 patients and 11 patients without and with epitrochlear involvement were 80% and 90%, respectively. Two of the 11 CS IA–IIB and 3 of the 6 CS III–IV patients experienced recurrence. None of the recurrences involved the epitrochlear or ipsilateral brachial region regardless of the treatment technique, and no complications from the local radiation therapy were observed. CONCLUSIONS Feasible and effective radiation therapy techniques are available for patients with HD with epitrochlear involvement. If appropriately treated, the prognosis of patients with this unique presentation appears to be similar to that of other HD patients. Cancer 2001;91:1213–8. © 2001 American Cancer Society.

Significance of epitrochlear lymph node involvement in Hodgkin disease

Epitrochlear involvement in Hodgkin disease (HD) is a rare event, with only limited data available describing this unique presentation, its treatment, and long term outcome. Between 1968 and 1997, 1180 patients with clinical stage (CS) IA-IIB HD were treated at the Harvard Longwood Area Hospitals, among whom 11 were identified to have presented with epitrochlear lymphadenopathy (1%). Together with 6 CS III-IV patients also with clinically involved epitrochlear lymph nodes at diagnosis, these 17 patients form the basis of the current study. The clinical characteristics, histopathologic distribution, and treatment details are described. Two radiation therapy techniques were used: the "single field" and "separate-field" techniques. The median dose to the epitrochlear region was 3600 centigrays. Survival outcome was calculated by the Kaplan-Meier method. The median follow-up was 17 years. The actuarial 15-year freedom from recurrence, cause specific survival, and overall survival (OS) rates for the 17 patients were 70%, 88%, and 70%, respectively. Among the CS IA-IIB patients, the 15-year OS rates of the 1169 patients and 11 patients without and with epitrochlear involvement were 80% and 90%, respectively. Two of the 11 CS IA-IIB and 3 of the 6 CS III-IV patients experienced recurrence. None of the recurrences involved the epitrochlear or ipsilateral brachial region regardless of the treatment technique, and no complications from the local radiation therapy were observed. Feasible and effective radiation therapy techniques are available for patients with HD with epitrochlear involvement. If appropriately treated, the prognosis of patients with this unique presentation appears to be similar to that of other HD patients.

Prognostic importance of magnetic resonance imaging in bone marrow involvement of Hodgkin disease.

Determination of bone marrow involvement is important in staging Hodgkin disease (HD), so we compared the effectiveness of magnetic resonance imaging (MRI) with bone marrow biopsy in diagnosing bone marrow involvement in HD patients. Twenty-six patients with the diagnosis of HD were included in this study. The ages of the patients were between 4 and 24 years, with a median of 12. Eleven of them had stage III or IV disease and 15 had been previously diagnosed as having HD and were in relapse. They were evaluated by bone marrow biopsy and MRI of lumbar vertebrae. The biopsies were taken from the anterosuperior iliac spine with an age-appropriate Jamshidi biopsy needle. Within 14 days following biopsy, MRI of lumbar vertebrae was carried out. MRI revealed decreased signal intensity in T1-weighted images in 7 of 26 patients. On the other hand, bone marrow biopsies showed HD involvement in three out of seven patients. The remaining 19 patients who had normal bone MRI were negative for HD in their bone marrow biopsies. The patients with positive MRIs and negative biopsy for HD had bone pain. One of them had a femoral periosteal reaction on bone survey; the other two had height loss in their lumbar vertebral bodies. There was a statistically significant difference in the disease-free survival rates between MRI-positive and -negative patients in the following 24 months period (P < 0.0001). This study suggests that MRI is a useful method for diagnosing bone marrow involvement in HD, in that our MRI-positive patients had a higher relapse rate in the 24 months follow-up period than the MRI-negative patients.

Unilateral proptosis in an immunocompetent man as the initial clinical manifestation of systemic Hodgkin disease

Objective Orbital involvement in Hodgkin disease (HD) is rare. Previously reported cases of HD in patients without the acquired immunodeficiency syndrome have been diagnosed late in the course of established systemic disease. The authors describe an immunocompetent man with orbital infiltration as the initial manifestation of systemic HD. Design Case report. Participants A 47-year-old man with acute progressive, painless proptosis of the left eye is described. Intervention A well-defined, homogeneous soft tissue mass of the superior left orbit was evident on computed tomography, and an incisional biopsy of the nontender mass was performed. Results The histopathologic findings were characteristic of HD. Systemic investigations showed clinical stage 3A HD. Ten months after completion of hybrid chemotherapy, the patient remained in complete remission from his HD. Conclusion Hodgkin disease presenting initially in the orbit of a patient with the acquired immunodeficiency syndrome has been described previously. The patient presented in this report is the first case of HD in the recent English literature with the initial manifestation in the orbit of an otherwise immunocompetent patient.

The Consistent Association Between Epstein-Barr Virus and Hodgkin's Disease in Children in Kenya

Recent studies have suggested that Epstein-Barr virus (EBV) may play a role in the etiology of Hodgkin's disease (HD). In a previous study, we used a latent membrane protein 1 (LMP1)-specific antibodies to examine archival material from 74 British children with HD and found 50% of cases to be positive. It is known that there are geographic and ethnic variations in the incidence of HD. We have investigated LMP1 status in formalin-fixed, paraffin wax-embedded lymph nodes with HD involvement from 53 children and 48 adults from Kenya using immunohistochemical staining. We also developed sensitive and specific in vitro gene amplification protocols for examining the EBV strain type in such material using several combinations of primers derived from the EBNA 2 and EBNA 3 coding regions. LMP1 positivity was present in 100% of the pediatric cases (two lymphocyte-predominant, 25 nodular sclerosis, 16 mixed cellularity, 5 lymphocyte depletion, and 5 unclassified) and in 66% of the adult cases (two of three lymphocyte-predominant, 26 of 39 nodular, sclerosis, two of two mixed cellularity, and two of four lymphocyte depletion). Tests to type the EBV strain were undertaken in 25 EBV-positive pediatric cases. A combination of type-specific polymerase chain reactions for EBNA 2 and EBNA 3C genes indicated that seven patients had type 1, eight had type 2, and 10 had dual infections with both types. Five cases with dual infections were further investigated using a sensitive in situ hybridization for the EBV-encoded, small nuclear nonpolyadenylated RNAs (EBERs). EBER transcripts were detected in Reed-Sternberg and Hodgkin cells and in occasional infiltrating lymphocytes. These observations indicate that in Kenya EBV is consistently associated with pediatric cases of HD, and that biopsies from a number of such cases appear to carry both type 1 and type 2 viral sequences.

Thymic involvement in Hodgkin disease: CT and sonographic findings.

To evaluate the morphologic characteristics and frequency of thymic enlargement in Hodgkin disease, the initial and follow-up computed tomographic (CT) scans of 43 patients with newly diagnosed Hodgkin lymphoma were retrospectively analyzed. Sonograms of the thymic region in 21 patients were also available and were compared with the CT scans. Initial CT scans showed thymic enlargement in 17 of the 43 patients, no evidence of thymic enlargement in 15 patients, and equivocal findings in 11 patients. Analysis of follow-up CT scans indicated that seven of the 11 patients with initially equivocal findings had had thymic enlargement. In all seven patients, the anterior mediastinal tumor shrank with therapy and adopted a typical tongue-shaped thymic configuration. In nine of the 24 patients with thymic enlargement, the thymus remained enlarged after therapy and full clinical remission. The comparison of sonograms and CT scans showed that sonography could not help differentiate the normal-size thymus from surrounding fatty tissue. All thymic glands that were considered diseased because of enlargement at CT were sonographically visible due to an abnormal, hypoechoic structure. The results of the study show that thymic enlargement presumed to be due to involvement by Hodgkin disease seems to occur more frequently than previously reported.

Peripheral blood lymphocyte response to recombinant and non-recombinant interleukin 2 in previously treated patients with Hodgkin's disease, long-time off-therapy.

13 patients with Hodgkin's disease (HD) previously treated, 9 of whom were long-time (more than 2 yr) off-therapy, were studied for peripheral blood lymphocyte response to interleukin 2 and for lymphocyte subpopulations by means of in vitro cultures and monoclonal antibodies. The aim of the study was to ascertain the role played by interleukin 2 in the impaired cell-mediated immunity of HD patients. The results show a response of peripheral blood mononuclear cells of HD patients to either the T cell-specific polyclonal mitogens PHA and Con A or to the T cell-dependent, although B cell-specific, PWM, most significantly decreased compared to the normal response. As far as the interleukin 2 involvement in HD is concerned, our study suggests: an impaired endogenous interleukin 2 production by T lymphocytes, a most probable deficiency of the interleukin 2 receptor (Tac) expression and 3) a decrease of the number and/or of the function of NK cells no longer responsive in vitro to interleukin 2. The phenotypic analysis of peripheral blood mononuclear cells showed a slight decrease of total T cells (T3+), of the helper/inducer subset (T4+) and of the T4+/T8+ cells ratio. Our data seem to support the rationale for a therapeutical approach with interleukin 2 in controlled clinical trials also in HD patients, according to the experiments in progress in solid tumor patients.

Assessment of liver and spleen involvement in Hodgkin's disease.

Prognosis and proper treatment in Hodgkin's disease (HD) are strictly related to staging accuracy: liver and spleen involvement is of particular importance in this regard. We have evaluated, in 113 consecutive patients, the accuracy of clinical parameters to detect histologically documented HD involvement by comparing hepatosplenomegaly, liver function tests, liver and spleen scan, inspection of liver and spleen surface at laparoscopy with histologic findings. Our data suggest that of all the parameters studied, laparoscopy has the highest sensitivity and specificity values (about 100%). Laparoscopy may precede laparotomy as a staging procedure in HD and may give, in patients not submitted to laparotomy whatever the reasons, very reliable information.

Hodgkin's disease of the nasopharynx

Malignant lymphoma of the Hodgkin's disease type involving the nasopharynx has been considered a rare entity. However, recent publications suggest that such involvement may not be uncommon. The authors describe their experience with two patients with histologically proven involvement of the nasopharynx by Hodgkin's disease. The diagnosis is difficult to establish. Histologic confirmation may require persistence and necessitates close cooperation with the pathologist. The prognostic significance of Hodgkin's disease involvement of the nasopharynx remains unknown. The otolaryngologist should be aware of these issues and be available to assist in the evaluation of the patient with lymphoma.

On the size and tumor involvement of the spleen in Hodgkin's disease.

Fifty-four untreated patients with Hodgkin's disease (HD) subjected to splenectomy were studied with respect to preoperatively assessed spleen size compared to postoperative findings. Before splenectomy, nine patients had "normal sized" spleens, 18 patients had spleens weighing greater than or equal to 200 g and 14/39 spleens were tumor-involved. Nine patients had "enlarged" but unpalpable spleens. Eight of these weighed greater than 200 g and 3/9 spleens showed tumor involvement. Six patients with preoperatively palpable spleens showed tumor involvement, their spleens weighed greater than 660 g. The results confirm the inaccuracy of non-invasive procedures in prediction of spleen size and tumor involvement in HD.

An evaluation of intraabdominal involvement in Hodgkin disease.

An analysis of the staging procedure in 80 patients with histologically confirmed Hodgkin disease was performed at Tata Memorial Hospital, Bombay. There was a marked male preponderance. The mixed cellularity type of Hodgkin disease is the commonest histological variety (47.5%) and has the highest incidence of subsequently proven generalized disease (76%). The lymphocytic predominant variety was the next most common (27.5%) and was present as unsuspected disease in 45% of cases. Systemic symptoms were associated with advanced disease in 57% of clinical IB and 73% of clinical IIB cases. Splenic involvement was histologically confirmed in 41% of cases with stage I disease and 52% of cases with stage II disease and was associated with liver involvement in two cases. A lymphogram was performed, in addition, prior to the laparotomy in 40 cases and the lymphogram-laparotomy concordance was approximately 72% in our series. This stresses the importance of a staging laparotomy.

Acquired ichthyosis in Hodgkin's disease; report of a case.

In patients with Hodgkin's disease involvement of the skin by any of several lesions is well recognized. The onset of ichthyosis vulgaris in an adult with no previous personal or familial history of this disease is unusual. Therefore, the simultaneous occurrence of Hodgkin's disease and ichthyosis leads one to suspect a cause and effect relationship. Two cases of this combination have previously been reported.1In addition, one case of lymphosarcoma has been reported accompanied by acquired ichthyosis.2This association is considered to be of interest because the onset of ichthyosis in a patient with no other visible lesions may be the clue to an otherwise occult Hodgkin's disease or lymphosarcoma. In the following patient, the cutaneous lesion was the presenting complaint. A single painless lymph node was all but unnoticed by him; yet it disclosed the histologic diagnosis of Hodgkin's disease. From the dermatologic standpoint, the acquired ichthyosis

Vertebral Involvement in Hodgkin's Disease

THE incidence of bone involvement in Hodgkin's disease is much higher than we have been led to believe by reports in the literature, and a more frequent complete radiologic investigation of the skeleton in cases suspected of Hodgkin's will, not infrequently, show osseous involvement, even though this may not be clinically suspected. Jenkinson states that in the study of his cases there was evident a similarity between bone metastases of carcinoma and bone changes in Hodgkin's disease. Reisner and Brada state that in their series of Hodgkin's cases, 74 per cent presented bone involvement, and in approximately 50 per cent of these, the lesions were situated in the spinal column. Bone involvement, however, is usually considered a late development in the course of the disease. As in carcinoma, the vertebra, ribs, pelvis, and femora are most frequently the site of changes in Hodgkin's disease. Lock-wood, Johnson, and Narr report a case of a boy, aged 15 years, in whom a roentgenogram revealed definite bone des...